Top 3: UK Coordinated Care Findings

Care Coordination is a key concern in the UK healthcare landscape as it is globally. The need for systems to be integrated in order to reap business process benefits as well as capitalizing on the sheer mass of data that healthcare organizations produce on a daily basis is driving healthcare providers to seek out assistance from IT service providers to not only establish an integrated infrastructure but to also guide them through the possibilities of what value can be attained through this exercise. Today, I look at three characteristics of the UK healthcare ecosystem and its current status with coordinated care.

1. Healthcare providers struggle to coordinate care outside of the hospital: Between 2013 and 2014, the National Survey of Bereaved People (VOICES) was commissioned by the NHS to assess experiences of care in the last three months of patients' lives. The key point that stood out the most in my opinion was that healthcare providers struggle to coordinate care when the patient is outside of their usual care setting whether that be a hospital or at home. By no means is there a lack of technology in this area to enable coordination as there is a multitude of devices and means of communicating between care sites. The healthcare ecosystem however struggles with streamlining, integrating and standardizing workflow processes and in conjunction with telehealth technological developments, this is where IT service vendors need to be able to add value to their clients and ultimately their patients.
2. The introduction of the NHS vanguard sites demands care coordination: In January 2015, the NHS launched a program inviting individual organizations and partnerships to apply to become 'vanguard sites'. These are, in essence, test cases for new models of care going forward. Looking at the requirements set forth by the NHS, it is clear that success will not be possible without coordinated care. Throughout the ideologies of what the new models of care will look like, we see direct references to becoming an "integrated provider", having a "joined-up electronic health record" and using "patient population segmentation". In fact, the description of 'Enhanced health in care homes', even references how new telehealth technologies can be applied to provide better care. Together with MarketsandMarkets' forecast that the Population Health Management market will grow at a staggering 26% CAGR between 2013-2018, this further supports the need for IT vendors to sharpen up their integration capabilities and offer solutions that genuinely deliver coordination across the IT landscape.
3. The NHS is investing in support for harnessing technology such as interoperability: On the 31st July 2015, the NHS published a support pack for all vanguard sites. In section 5 of this document, it speaks to what will be made available for participating vanguard sites. Apart from a £200m transformation fund (of which around £140m remains unallocated as of this blog post), they plan to provide dedicated support for items such as interoperability, information governance and digital strategy. They are also looking to leverage best practice examples both from within and outside of the UK and so IT vendors will need to ensure they have solid case studies to back up their sales pitches.

Best Regards,

Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC

1. Office for National Statistics, Statistical bulletin: National Survey of Bereaved People (VOICES), 2013, http://www.ons.gov.uk/ons/rel/subnational-health1/national-survey-of-bereaved-people--voices-/2013/stb---national-survey-of-bereaved-people--voices-.html?format=print
2. NHS England, New care models – vanguard sites, http://www.england.nhs.uk/ourwork/futurenhs/5yfv-ch3/new-care-models/
3. MarketsandMarkets, Population Health Management Market worth $40.6 Billion by 2018, http://www.marketsandmarkets.com/PressReleases/population-health-management.asp
4. NHS England, Vanguard support package launched, 31 July 2015, http://www.england.nhs.uk/2015/07/31/vanguard-support/

Accenture: Using terminology as a competitive differentiator

I'd like to reference two articles in this blog post if I may. The first was written by Stuart Lauchlan of Diginomica entitled 'Don't mention the outsourcing, but dig deep into digital at Accenture'. In this article, he credits Accenture with entering the 'digital' market early as it is now reaping the rewards of strong, consistent growth. Lauchlan later goes on to recall how Pierre Nanterme, Accenture CEO, chose to abandon traditional terminology such as 'consulting' and 'outsourcing' as he believed they did not represent Accenture's true capabilities. My initial reaction to this is that it was a clever and easy move to make. Although there has been significant changes in the IT world, does Accenture still outsource? Yes. Does Accenture still consult? Yes. Nothing has changed drastically, yet it has re-branded its marketing strategy to align itself with market demand.

The second article I'd like to refer to was written by Varun Sinha entitled 'How Accenture Has Emerged as a Threat to Infosys, Wipro'. Like the former, this was written following Accenture's quarterly earnings announcement and it goes on to describe how Accenture's growth both signaled a growing market for India-led vendors but also increased competition as Accenture continues to grow faster. It is touched upon briefly in this article but what struck me was the notion of whether Accenture's decision to abandon traditional terminology was a way of differentiating itself from traditional, India-led competitors.

Instinctively, when you hear the word 'outsourcing', it leads you to the thought of reducing operations in one country in favor of a lower cost country. This fundamental thought process was originally a competitive differentiator for India-led organizations but with Accenture's repositioning of terminology, it can now bask in the perceived imagery of higher value services at a premium.

Finally, I looked at relative R&D spend statistics among some of the largest IT services vendors to see whether this repositioning was potentially supported by investment. Although it doesn't go into detail of how R&D was spent, Accenture's R&D spend as a percentage of its annual revenue rose from 2.01% (2012) to 2.50% (2013), a rise of over $150m, before settling back down in 2014. Other vendors had either reduced/maintained R&D spend or increased its percentage as part of a lower annual revenue whereas Accenture saw a rise in both. Although not conclusive, this suggests that Accenture could have invested in digital technologies to support its marketing efforts.

I commend Accenture for the foresight to take this step. The question I'd like to leave you with is this: 'Which era will we be entering next?' Maybe 'virtual services' for example? I'd love to hear what you have to think so please leave your comments below and if you've enjoyed reading this post, feel free to share it on social media.

Best Regards,

Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC

1. Diginomica, Don’t mention the outsourcing, but dig deep into digital at Accenture, http://diginomica.com/2015/06/26/dont-mention-the-outsourcing-but-dig-deep-into-digital-at-accenture/#.Va0P7PlViko, 26th Jun 2015
2. NDTV Profit, How Accenture Has Emerged as a Threat to Infosys, Wipro, http://profit.ndtv.com/news/corporates/article-how-accenture-has-emerged-as-a-threat-to-infosys-wipro-775537, 26th Jun 2015

Analyzing the Genpact Payer infographic

I recently saw an infographic from Genpact (available here) on the top concerns for Payers and found it very interesting and insightful. The survey was conducted across 920 senior executives in Payer organizations in North America.

The survey found that the top three concerns were: Compliance, Customer Satisfaction and Cost Reduction. It then goes into what solutions Payers believe would have a material effect on these concerns. At this point, I'd like to present the data in a slightly different way. The table below shows the percentage of survey respondents who believe that the solution on the left can have a material impact on the top three concerns at the top.

* Colours represent heat mapping from low response % (red) to high response % (green)

There are several ways of looking at this but one of the biggest takeaways for me personally is in the BI & Analytics row. 

Almost 3/4 of survey respondents believe that BI and Analytics can help reduce costs. This may not be where your eye is immediately drawn to from this table but when you read further down, it then shows you that Payers' BI & Analytics capabilities are still viewed as immature by almost a third of respondents and that 40% believe they are unprepared. It seems as though, even across industries, we have only just scratched the surface of what is possible through the use of analytics and so it is understandable that Payers will require support to achieve the full potential of this solution area.

If we work our way down the infographic, we then see that 51% of respondents believe that an improved use of Information Technology can have a material impact on the function and that 70% have initiatives underway in BI & Analytics. Although this is a large percentage, why isn't it higher? Presumably, some Payers are holding back to see what lessons are learned by early adopters but at this stage, surely they are risking falling behind the pack. 

If we finally look at the last two rows, interestingly we find that respondents do not believe that BI & Analytics doesn't necessarily require Business Process Re-engineering or Advanced Organizational Structures. Other areas such as Customer Service and Claims Processing & Adjudication score much higher as necessary for improvement.

If we therefore look at BI & Analytics in its entirety, in regards to this infographic, we see that the potential value to the Payer is huge as is the opportunity for IT vendors to support them in making this a reality. 

Best Regards,

Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC

1. Genpact, Healthcare COO’s untapped strategic lever: Advanced operating models, http://www.genpact.com/docs/resource-/healthcare-coos-untapped-strategic-lever-advanced-operating-models

Analyzing the HP Sales Approach

This month we've been looking at HP within the Healthcare sector. With so much activity going on at the moment including the company split, the acquisition rumors and of course the $11b DHMSM result looming, it's a very eventful time to be focusing on HP and so in this blog post, we are going to be looking at HP and a few of the characteristics of HP's go-to-market sales approach, enjoy!

• Speak to the CIO whilst partners speak to the business: HP, like CSC, is seen very much as a technology player and it is happy to carry on fulfilling that role. Its in-road into a client is usually via the CIO, which is completely understandable. HP also has a strong partner network with vendors who speak more to the LoBs, such as Deloitte and so will rely on them to deepen the client relationship where necessary.
• Solution-in-a-box: HP typically prefers to craft a solution that can be implemented easily, quickly and cleanly. Once this solution is formulated, it can then work on customizing it and pitching it to different vertical industries.
• Leverage eHealth centers in India: As well as increasing headcount in India as part of its restructuring plan, HP is also leveraging its six eHealth centers in India. This has potential benefits both for the local communities as well as strengthening its value propositions around big data and telehealth for example.
• Concentrate on maintaining and growing existing client base: As its core business continues to dwindle, HP is fighting to at least maintain its existing client base and capitalizing on the loyalty its clients have to EDS after its acquisition.
• Capitalize on the regulatory environment: The ICD-10 deadline gives HP the opportunity to really push the value of its RCM and BPO solution portfolio.

Once again, many thanks for taking the time to read this blog post. If you enjoyed it and would like to see more then please share this on social media.

Best Regards,

Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC

Coordination > Consolidation

As we have seen over previous years, there has been widespread consolidation in the healthcare market. Both providers and payers alike have been making acquisitions within their locales. Their goals include improving integration across their organization while reaping other benefits such as expanding revenue streams. Although this may seem a viable option right now, this will present challenges in the near future and so here are a few reasons why coordination might be a better bet than consolidation:

Consolidation

• Fewer options will result in higher cost for the patient: In some areas of the US, there are only one or two insurers. As competition decreases, the market drives towards a virtual monopoly and these payers are able to demand higher prices from consumers. This will drive consumers to seek out alternatives, and with this consumer demand will come new independent entrants into the market delivering a greater quality/value proposition, with whom the larger, consolidated health systems will struggle to compete.
• The rise of telehealth: As payers and providers consolidate, they solely focus on their immediate locale. With the gradual increase in adoption of telehealth, these regional borders will start to fade and patients will be exposed to more future-ready and cheaper alternatives leaving the larger, more expensive networks behind. Although consolidated health systems have the ability to drive scale and invest in telehealth, they are likely to be increasingly subjected to competitors further afield who can offer cheaper telehealth services from remote locations for non-critical care.
• Consolidation doesn't necessarily reap economies of scale: One reason why providers are looking to consolidate is to grow economies of scale. However, a 2012 study by the Robert Wood Johnson Foundation found that the main driver was to simply improve bargaining power with payers and so consolidation did not lead to true integration or enhanced performance.

Coordination

• Remain agile: Formal and informal care coordination enables both payers and providers to leverage their partner networks whilst also remaining agile enough to respond to market shifts, new competition and consumer demand. Larger, consolidated systems will find themselves unable to compete on price in a market where already around 20% of Americans cannot afford health insurance. This is supported by the RWJ Foundation study which found that price increases exceeded 20% when mergers occurred in concentrated markets. 
• Coordinated care encourages a value-based reimbursement model: As mentioned above, although consolidation seems to promote care coordination on the surface, it is usually due to financial reasons and so fails to achieve improved patient care. As the healthcare market progresses from a fee-for-service model to a value-based-care model, providers will be judged on the quality of care they are administering. A true effort to coordinate care will improve the quality of care whereas those purely looking for financial benefit may end up having to play catch-up.
• A multitude of both financial and operational benefits: The benefits of care coordination range from empowering patients, improving the delivery of care and increased efficiency to reduced costs, streamlined workflows, reduced waiting times and improved patient outcomes. Providers who have not consolidated have still been able to reap the benefits of coordinated care and so it makes sense to integrate, coordinate and remain agile.

Best Regards,

Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC

Bridging the Payer-Provider trust gap

Through my research into the Healthcare Payer market, it is apparent that there is a significant trust issue between Payers and Providers. In a market where we're seeing an ever increasing percentage of convergence between the two parties, this mistrust serves as an unwelcome roadblock to innovation and unfortunately the patients are likely to be the ones who suffer.

As we've seen in the recently published PayerView report by Athenahealth and ReviveHealth, although overall benefit reliability is improving, there is still a lot of work to do in regards to streamlining workflows, making processes more efficient and ultimately bridging the trust gap.

In this blog, I'm going to lay out a few recommendations for both Payers and Providers on how to build trust with the other party based on what I've come across during my research. Many of these points apply to both entities but for the purposes of this blog post, we'll look at them separately:

Payers

• Remain agile: As can be seen in the PayerView rankings, the top two performers are small, commercial players. Although there's a general assumption that smaller organisations are more agile, regardless of the size, Payers must be able to quickly react to market shifts including regulatory changes.
• Integrate and coordinate your data: Easier said than done but integrating and coordinating your data will have many benefits as it will streamline workflows, simplify claims processing and make transactions more accurate and efficient. Also, once your data is aggregated, this then enables you to analyze it for future improvements.
• Communicate: Communication is vital with both patients and Providers. Technologies such as portals, patient accessible EHRs, mobile access and secure messaging will engage patients while clinical information sharing, timely pre-authorizations and a reduction of unnecessary procedures will bridge the gap with Providers.

Providers

• Learn from Payers: Payers are well versed in areas such as patient engagement despite Providers having more direct contact. With the rise of technologies like telehealth, remote monitoring, mobile access etc, Providers should look at what Payers are doing to retain and engage patients and if appropriate, learn from them.
• Invest in HIT: Payers are more likely to contract with Providers who deploy software and systems supporting clinical integration and Population Health Management. The associated analytical efforts based on these would help Payers in calculating more accurate insurance premiums as well as having many patient health benefits.
• Discuss financial risk bearing: As the market embraces a value-based reimbursement model, one of the primary reasons Payers do not trust Providers is the unwillingness to accept financial risk. Once again, this is not an easy fix but clear and transparent communication on mutual goals will certainly help this process.

Once again, many thanks for taking the time to read my blog. I hope you found it useful and welcome any feedback you may have. If you enjoyed this post, please feel free to share it on social media with your friends and colleagues.

Best Regards,

Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC

1. Athenahealth, PayerView 2015, http://www.athenahealth.com/network-data-insights/payerview
2. Managed Healthcare Executive, Best practices for payers and providers to cooperate in the era of convergence, http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/best-practices-payers-and-providers-cooperate-era-convergence, 23 Dec 2014
3. HealthcareIT News, Engaging patients: 5 things providers can learn from payers, http://www.healthcareitnews.com/blog/engaging-patients-5-things-providers-can-learn-payers, 8 Sep 2014
4. FTI Consulting, Gap Separates Payers and Physicians on Value-Based Arrangements, According to a New Study Released by FTI Consulting, http://www.fticonsulting.co.uk/global2/press-releases/united-states/gap-separates-payers-and-physicians-by-fti-consulting.aspx, 30 Jul 2014

Best of the Best: Analyzing the leaders in Healthcare

Welcome everybody to another Health Care Bear blog post! This month, I've been looking at industry award winners in healthcare in an effort to find the best use cases of technology and identify patterns between them that could be emulated for other healthcare systems.

For the purposes of my research, I have analyzed three of the HIMSS Davies Enterprise Award winners based on their use of IT (primarily EHR implementations.) These are (in no particular order: Children's Health System of Texas (Children's), Texas Health Resources (THR) and the University of Iowa Hospitals & Clinics (UIHC.) To make it a little easier, I am focusing on US based healthcare systems as healthcare structures vary greatly from country to country. These are a few of the key notes from my research:

1. UIHC absolutely dominated against the other two chosen hospitals by achieving not only the most ROI ($103.6m (159%)) of the three but also invested the least to achieve this ($65.30m), which is incredible.
2. Even if UIHC hadn't received Government incentives, it still would have achieved 104% ROI, mainly due to the financial benefits of integrating monitoring devices which reaped $37.16m (36% of total ROI.)
3. Both Children's and THR have a common IS Vendor Selection Strategy in that they are looking to migrate towards a single vendor approach. UIHC however is looking to migrate toward best of suite/cluter throughout its organization. What is interesting is that this approach is also taken by the top 3 most profitable healthcare systems of America*.
4. The same pattern arises as UIHC is the only hospital not stated as having a Health Information Exchange (HIE) / Regional Health Information Organization (RHIO) initiative either planned or in use.
5. The number of IT vendors these hospitals deal with is staggering with 70 listed between the three chosen for this research. Considering two of them are looking to reduce the number of vendors, this could lead to significant vendor landscape consolidation.

That's it for now folks! Many thanks for staying tuned and as always, I'd love to hear your feedback in the comments below and if you liked this post, please spread the word via social media and finally check out my earlier blog posts. Ciao for now!

* Top 3 most profitable healthcare systems of America selected through the ownership of the top 20 most profitable hospitals of America.

Best Regards,

Jonathan Cordwell
Research Analyst, Healthcare Strategy
ResearchNetwork, CSC

1. HIMSS Enterprise Davies Award Recipients, http://www.himss.org/resourcelibrary/TopicList.aspx?MetaDataID=2803